Implementation of couples' voluntary HIV counseling and testing services in Durban, South Africa

• Type of Material: Article
• Authors: William Kilembe, Emory University; Kristin Wall, Emory University; Mammekwa Mokgoro, University of Kwazulu Natal; Annie Mwaanga, Emory University; Elisabeth Dissen, Emory University; Miriam Kamusoko, Emory University; Hilda Phiri, Emory University; Jean Sakulanda, Emory University; Jonathan Davitte, Emory University; Tarylee Reddy, Medical Research Center; Mark Brockman, Simon Fraser University; Thumbi Ndung'u, University of Kwazulu Natal; Susan Allen, Emory University
• Language: English
• Date: 2015-07-02
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2015 Kilembe et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12889-015-1959-z
• Title of Journal or Parent Work: BMC Public Health
• ISSN: 1471-2458
• Volume: 15
• Issue: 1
• Start Page: 601
• End Page: 601
• Grant/Funding Information: This work was supported by the Canadian Global Health Research Initiative (GHRI) International Development Research Centre (Project Number: 107017–001), the Emory Center for AIDS Research (P30 AI050409), and the AIDS International Training and Research Program Fogarty International Center (D43 TW001042).
• Keywords: ACCEPTABILITY; SEROCONVERSION; Implementation science; HETEROSEXUAL COUPLES; Public, Environmental & Occupational Health; South Africa; PREVALENCE; Heterosexual couples; Life Sciences & Biomedicine; POPULATION; RISK REDUCTION INTERVENTION; INFECTIONS; Science & Technology; HIV prevention; DISCORDANT COUPLES; SEXUAL-BEHAVIOR; SUB-SAHARAN AFRICA; Couples' HIV voluntary counseling and testing
• Research Categories: Health Sciences, Pathology; Health Sciences, Public Health

Abstract

Background: Couples' voluntary HIV counseling and testing (CVCT) is an evidence-based intervention that significantly reduces HIV incidence in couples. Despite the high prevalence of HIV and HIV couple serodiscordance in South Africa, there are few CVCT services. Methods: From February-June 2013, The Rwanda Zambia HIV Research Group provided support, training, and technical assistance for local counselors and promoters to pilot CVCT services in five hospital-based clinics in Durban, South Africa. Client-level data (age, gender, years cohabiting, pregnancy status, previous testing, antiretroviral treatment (ART) status, neighborhood, and test site) collected as a component of routine CVCT service operation is presented stratified by couple serostatus. Results: Twenty counselors and 28 promoters completed training. Of 907 couples (1,814 individuals) that underwent CVCT, prevalence of HIV was 41.8 % and prevalence of HIV serodiscordance was 29.5 % (19.3 % M-F+, 10.3 % M + F-). Most participants were 25-34 years of age, and this group had the highest prevalence. Previous individual HIV testing was low (50 % for men, 63 % for women). Only 4 % of couples reported previous CVCT. Most (75 %) HIV+ partners were not on ART, and HIV+ individuals in discordant couples were more likely to be on ART than those in concordant positive couples. Pregnancy among HIV+ women was not associated with previous HIV testing or ART use. Conclusions: Implementation of standard CVCT services was found to be feasible in Durban. The burden of HIV and couple serodiscordance in Durban was extremely high. CVCT would greatly benefit couples in Durban as an HIV prevention strategy.